Department of Medical Oncology, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.
Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China.
BMC Cancer. 2020 Aug 8;20(1):742. doi: 10.1186/s12885-020-07254-w.
Several studies have reported the incidence of interstitial pneumonia (IP) among patients with non-Hodgkin lymphoma (NHL) that are undergoing combination chemotherapy plus rituximab; however, the effective prophylactic treatment for IP remains unclear. This study aims to explore the prophylactic effect of trimethoprim-sulfamethoxazole (TMP-SMX) on IP and identify IP-associated risk factors in NHL patients.
Between March 2013 and April 2018, 498 patients (264 males, 53%) with B-cell NHL undergoing first-line RCHOP-like chemotherapy treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone were enrolled in this study.
These patients had a median age of 56 years, and 311 of the 498 patients (62.4%) were administered once daily with the prophylactic treatment of TMP-SMX. IP occurred in 65 patients (13.1%), indicating a significant reduction in the IP incidence rate (21.4% vs. 8.0%; p < 0.001). Among patients treated with TMP-SMX, 2 (1.2%) exhibited rashes, 38 (12.2%) suffered from nausea and vomiting, 52 (16.7%) showed signs of neutropenia, and 18 (5.8%) suffered from kidney dysfunction. Both univariate and multivariate analysis showed that gender (male), history of diabetes, and absence of prophylactic TMP-SMX treatment were significant risk factors associated with IP. Disease progression was observed in 55/311 (17.7%) patients that underwent prophylactic TMP-SMX treatment and in 63/187 (33.7%) patients that did not (p < 0.001).
This study revealed that the occurrence of IP was common in B-cell NHL patients undergoing combined chemotherapy plus rituximab treatment. IP could be reduced with prophylactic treatment of once-daily oral TMP-SMX.
多项研究报道了接受联合化疗加利妥昔单抗治疗的非霍奇金淋巴瘤（NHL）患者中间质性肺炎（IP）的发生率；然而，IP 的有效预防治疗仍不清楚。本研究旨在探讨复方磺胺甲噁唑（TMP-SMX）对 IP 的预防作用，并确定 NHL 患者中与 IP 相关的危险因素。
2013 年 3 月至 2018 年 4 月，498 例 B 细胞 NHL 患者（男 264 例，53%）接受一线 RCHOP 样化疗联合利妥昔单抗治疗，包括环磷酰胺、阿霉素、长春新碱和泼尼松。
这些患者的中位年龄为 56 岁，498 例患者中有 311 例（62.4%）接受了复方磺胺甲噁唑的预防性治疗，每日 1 次。65 例（13.1%）患者发生 IP，表明 IP 发生率显著降低（21.4%比 8.0%；p<0.001）。在接受 TMP-SMX 治疗的患者中，2 例（1.2%）出现皮疹，38 例（12.2%）出现恶心和呕吐，52 例（16.7%）出现中性粒细胞减少，18 例（5.8%）出现肾功能障碍。单因素和多因素分析均表明，性别（男性）、糖尿病史和未行复方磺胺甲噁唑预防治疗是与 IP 相关的显著危险因素。接受 TMP-SMX 预防治疗的 311 例患者中，55 例（17.7%）出现疾病进展，而未接受 TMP-SMX 预防治疗的 187 例患者中，63 例（33.7%）出现疾病进展（p<0.001）。
本研究表明，接受联合化疗加利妥昔单抗治疗的 B 细胞 NHL 患者中 IP 较为常见。用 TMP-SMX 每日口服预防治疗可降低 IP 的发生。
